Monthly Archives: February 2016

Natural cancer remedies: sorting fact from fiction

Natural cancer remedies: sorting fact from fiction

November 10, 2015 2.40pm AEDT

While conventional treatments are subjected to rigorous research before they can be recommended for clinical use, alternative treatments are not. These “natural” remedies are either turned into over-the-counter medicines or can be taken in their natural forms.

It is important to note that alternative methods labelled “natural” are not necessarily “good”. Nor do they necessarily translate into healing. The use of traditional remedies should always be discussed with a physician or an oncologist. They may have adverse effects or may reduce the efficacy of conventional treatment.

Many alternative or traditional medicines claim to have the ability to heal but there is no scientific evidence to support this. In some cases scientific evidence may even contradict the claims.

Here are some of the myths and facts about natural products that purportedly have anti-cancer properties.

Fruit and vegetable pits

Chewing apricot pits were considered to have anti-cancer properties but this is not true. shutterstock

For generations the pits of many fruits, particularly apricots or kernels, have been promoted anecdotally to treat cancer. Traditionally the pits were chewed in their natural form. Amygdalin found inside apricot pits was thought to be the active ingredient linked to tales of its powerful anti-cancer properties.

But after nearly four decades of research, scientists cannot find any proof of its elusive chemotherapeutic effects.

What has been reported and is nearly guaranteed is that a person who uses this remedy will suffer the adverse effects of chronic poisoning caused by the cyanide found in some of these pits.

Overripe bananas

In 2009, an article investigating cancer-related biological activity in ripened bananas was published. The study could not make any direct link to the fruit as an anti-cancer remedy but included the following statement:

Due to the association between immunostimulatory and anti-oxidative effects, oral banana intake has the potential to help prevent lifestyle-related diseases and carcinogenesis.

The statement went viral in the media with many memes posted on Facebook suggesting ripened bananas could reduce cancer risk. While studies have demonstrated that antioxidants play an important role in protecting body cells against potential cancer agents, the article does not say bananas have an active ingredient that can combat cancer.

There are, however, remedies that have seen more positive results.

The tropical guayabano fruit

Different part of the soursop plant have anti-cancer properties. shutterstock

A member of the custard apple family fruit tree, Annona muricata, which is more commonly known as soursop, graviola or guayabano, is extensively eaten by indigenous communities in the tropical parts of northern Africa and South America. It is an oval-shaped, dark green, prickly fruit with a mildly acidic, whitish flesh.

When the plant was put through scientific tests, studies found that several parts had potentially potent anti-cancer properties. This was particularly shown to be the case when used as an adjunct treatment.

Research showed that the leaves have active ingredients that possess anti-cancer properties that kill lung, prostate, colon, breast, and pancreatic cancer cells. Its seeds display properties that perform the same task that chemotherapy treatment would, killing breast, oral and lung cancer cells. And its fruit component has anti-prostate cancer potential.

Traditionally, the leaves and or roots would have been brewed or crushed for consumption, and the fruit eaten. But extracts of the active ingredients from the leaves have been made into tablets and sold commercially. These are taken in conjunction with conventional chemotherapy.

South African rooibos herbal tea

Rooibos, which is only found in the Cederberg region of the Western Cape, South Africa, is known for its aromatic flavour. The plant has been found to have anti-cancer properties in in vitro and in vivo animal models.

Additional research shows that the herbal tea possesses ingredients that reduce oesophageal and liver cancer and skin tumours. Clinical trials in humans are being planned.

The Cancer Association of South Africa has endorsed the herbal tea’s potential as a form of natural chemoprevention. This means it can aid in preventing cancer and even possibly reduce the growth of cancer cells. And it has funded research projects aimed at identifying the active ingredients.

The Sutherlandia frutescens plant

Sutherlandia frutescens is indigenous to South Africa, Lesotho, southern Namibia and southeastern Botswana. It is commonly used in traditional medicine. This shrub-like plant has bitter, aromatic leaves and is known for its red-orange flowers during spring to mid-summer.

Studies show that it has anti-cancer properties against oesophageal, prostate, liver, breast and lung cancer cells. Recent studies proposed that cancer bush, the name it is commonly known by, may be a promising adjunctive therapy because of its potent anti-oxidative properties.

Preliminary clinical studies proved that it had no negative effects. And the indications are that it may act as an immune stimulant to support the cancer patient. It has been made into tablet form and commercialised but studies are continuing to produce more definitive evidence of its benefits.

It is currently being marketed as a natural remedy that can be used alongside conventional treatment.

Coix seed

Extracts from coix seeds has anti-cancer effects. shutterstock

Traditional Chinese Medicine is a significant component of alternative medicine. Initially confined to Asian countries, big Western pharmaceutical companies have recently started sifting through the orient’s vast indigenous knowledge for natural cancer remedies.

Kanglaite is an anti-tumour drug that was developed using modern technology. It contains extracts from coix seeds.

Research shows that Kanglaite has anti-cancer effects particularly in gastric, lung, and liver cancer. After passing the phase three clinical trials it was marketed along with conventional therapy to improve the patient’s quality of life.

Are Good Doctors Bad for Your Health?

Are Good Doctors Bad for Your Health?
[Ezekiel J. Emanuel]

Ezekiel J. Emanuel NOV. 21, 2015

PRETTY regularly, I receive an urgent call from a distraught friend or friend of a brother. “Zeke, Mom was at home and her heart stopped. The E.M.T.s are rushing her to XYZ hospital in Miami. Can you help me find the best cardiologist there for her?”
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“Get me the best cardiologist” is our natural response to any heart problem. Unfortunately, it is probably wrong. Surprisingly, the right question is almost its exact opposite: At which hospital are all the famous, senior cardiologists away?

One of the more surprising — and genuinely scary — research papers published recently appeared in JAMA Internal Medicine. It examined 10 years of data involving tens of thousands of hospital admissions. It found that patients with acute, life-threatening cardiac conditions did better when the senior cardiologists were out of town. And this was at the best hospitals in the United States, our academic teaching hospitals. As the article concludes, high-risk patients with heart failure and cardiac arrest, hospitalized in teaching hospitals, had lower 30-day mortality when cardiologists were away from the hospital attending national cardiology meetings. And the differences were not trivial — mortality decreased by about a third for some patients when those top doctors were away.

Truly shocking and counterintuitive: Not having the country’s famous senior heart doctors caring for you might increase your chance of surviving a cardiac arrest.

The researchers did interesting checks to be sure the results were valid. They noted that there was no difference in mortality from heart conditions when physicians were attending the cancer or orthopedic meetings, presumably because the oncologists and orthopedic surgeons, not cardiologists, attended those meetings and don’t care for patients with heart problems. And when the cardiologists were at their national meetings, there were no changes in mortality from nonheart conditions such as hip fractures.

Overall for all heart conditions examined, patients cared for at the teaching hospitals did significantly better than those cared for in community hospitals. So choosing a teaching hospital, when possible, makes a difference.

It is not clear why having senior cardiologists around actually seems to increase mortality for patients with life-threatening heart problems. One possible explanation is that while senior cardiologists are great researchers, the junior physicians — recently out of training — may actually be more adept clinically. Another potential explanation suggested by the data is that senior cardiologists try more interventions. When the cardiologists were around, patients in cardiac arrest, for example, were significantly more likely to get interventions, like stents, to open up their coronary blood vessels.

Every weekday, get thought-provoking commentary from Op-Ed columnists, The Times editorial board and contributing writers from around the world.

This is not the only recent finding that suggests that more care can produce worse health outcomes. A study from Israel of elderly patients with multiple health problems but still living in the community tried discontinuing medicines to see if patients got better. Not unusual for these types of elderly patients, on average, they were taking more than seven medications.


In a systematic, data-driven fashion, the researchers discontinued almost five drugs per patient for more than 90 percent of the patients. In only 2 percent of cases did the drugs have to be restarted. No patients had serious side effects and no patients died from stopping the drugs. Instead, almost all of the patients reported improvements in health, not to mention the saving of drug money.

We — both physicians and patients — usually think more treatment means better treatment. We often forget that every test and treatment can go wrong, produce side effects or lead to additional interventions that themselves can go wrong. We have learned this lesson with treatments like antibiotics for simple medical problems from sore throats to ear infections. Despite often repeating the mantra “First, do no harm,” doctors have difficulty with doing less — even nothing. We find it hard to refrain from trying another drug, blood test, imaging study or surgery.

There are potential policy solutions. One would require that doctors provide patients with data about a procedure, including its rate of success, complications and the like, before every major intervention. A solution for overmedication, especially in older people, would be to require that doctors attempt to discontinue medications at least once a year.

One thing patients can do is ask four simple questions when doctors are proposing an intervention, whether an X-ray, genetic test or surgery. First, what difference will it make? Will the test results change our approach to treatment? Second, how much improvement in terms of prolongation of life, reduction in risk of a heart attack or other problem is the treatment actually going to make? Third, how likely and severe are the side effects? And fourth, is the hospital a teaching hospital? The JAMA Internal Medicine study found that mortality was higher overall at nonteaching hospitals.

It is surprising how uncomfortable some physicians get when you ask these questions. No one likes to be second-guessed or have to justify their decisions. But studies show that when patients are systematically given information about benefits and risks they tend to consent to fewer interventions and feel more informed about their decisions.

So when your mother is being rushed to the hospital, it might be best not to seek the most famous senior doctor, but to ask those four questions.

Ezekiel J. Emanuel is an oncologist and a vice provost at the University of Pennsylvania

Trick or treat? Alternative therapies for menopause

Trick or treat? Alternative therapies for menopause

February 13, 2014 2.32pm AEDT

What really works to alleviate hot flushes and other symptoms of menopause? splityarn/Flickr

During menopause, estrogen levels drop, leading to a number of unpleasant symptoms.

The transition to menopause can significantly affect women’s quality of life, with many willing to try anything to alleviate the hot flushes, night sweats, decline in libido, backaches and other symptoms that result from their drop in oestrogen levels.

Hormone replacement therapy (HRT) is the most effective treatment for the relief of menopause symptoms and works by topping up declining oestrogen levels with synthetic version of the hormone. It’s effective around 80% to 90% of the time.

HRT comes with a small increase in the risk of breast cancer and blood clots. But due to the severity of the menopausal symptoms, many women believe the benefits of HRT outweigh the relatively small risks associated with the treatment. Being overweight, for instance, carries a far higher risk of developing breast cancer compared with the risks associated with taking HRT for less than five years.

A large clinical trial published a decade ago sparked widespread fears that HRT could cause cancer, stroke and heart disease. While the risks are now considered to have been overstated, they led to a dramatic decline in the use of hormone therapy.

Just because products are natural, doesn’t mean they’re risk-free. sanzibar/Flickr, CC BY-NC-SA

As many as 60% of women between the age 50 to 60 now use complementary and alternative treatments.

But while manufacturers are quick to claim to provide a wide array of benefits to menopausal women, in many instances, there’s little scientific evidence to show they work. Let’s look at what the science has to say about the safety and efficacy of these products.


Phytoestrogens are plant-derived compounds with a similar structure to human oestrogen, but are not as potent as the synthetic hormones used in HRT.


Isoflavones are a class of phytoestrogens widely consumed by women to treat menopausal symptoms, especially hot flushes. They’re found in soy beans, soy-based foods such as tofu, lentils, alfalfa sprouts and chickpeas.

Studies have shown isoflavones in soy may be beneficial for reducing cardiovascular disease and improving bone strength. But there is conflicting evidence on their effectiveness for treating menopausal symptoms. One study, for instance, suggested that isoflavone treatment may be effective only when the number of flushes experienced daily is relatively high.

Overall, it seems that soy in the diet of menopausal women may be beneficial and is unlikely to do harm.

Red clover

Red clover. randihausken/Flickr, CC BY-SA

Red clover is a plant compound that contains four different isoflavones (formononetin, biochanin A, daidzein, and genistein). It is available as a tablet, tea, or in liquid form and is widely used by menopausal women.

The data is mixed on the effectiveness of red clover to reduce menopausal symptoms. Some studies suggest it delivers no improvement over placebo while others report decreased frequency of hot flushes.

There have been no reported safety issues with taking red clover.

Herbal remedies

Herbal remedies have been used throughout the world as a traditional medicine for centuries, either in tea, tablet or powder forms.

Black cohosh

Black cohosh is an American perennial plant which has been used for hundreds of years to alleviate menopausal symptoms. It is the most studied herbal supplement, however, no researchers have identified its active constituent nor its mode of action.

Black cohosh. milesizz/Flickr, CC BY-NC-ND

Studies have demonstrated that black cohosh is mildly effective for alleviating hot flushes and mood swings.

It’s safe to use for up to six months, although there have been case reports of liver failure in women using black cohosh for longer periods.

Further studies are required to clarify whether black cohosh may work to alleviate symptoms by mimicking estrogen.


Maca, a biennial herbaceous plant native to Peru has been used historically used for its putative fertility-enhancing and aphrodisiac properties.

Maca is marketed based on reported benefits in relieving menopause symptoms, though there is scant published scientific data show it is effective and exerts any estrogenic activity.

Evening primrose oil

Evening primrose oil is obtained from the seeds of a biennial plant native to the United States. It contains high levels of omega-6 essential fatty acids and is widely used for skin disorders, rheumatoid arthritis, multiple sclerosis, chronic fatigue, asthma and gastrointestinal disorders.

Evening primrose plant. wanderingnome/Flickr, CC BY-NC-ND

Women have also been using primrose oil for decades for alleviating breast pain, endometriosis, and symptoms of menopause such as hot flushes.

As with other herbal supplements, the precise mechanism of action is not fully clear and the efficacy of evening primrose oil for relieving symptoms in menopausal women is not conclusive.

Dong quai

Dong quai is also prepared from the root of a perennial aromatic herb, this one native to China and Japan. Dong quai has long been used in traditional Chinese medicine to regulate menstrual cycle and alleviate menopausal symptoms.

Scientific evidence suggests it is ineffective for relieving menopausal symptoms. But when used in combination with other herbs (such as black cohosh, chasteberry, milk thistle, chamomilla and Siberian ginseng) appears to be useful in controlling hot flushes and other menopausal symptoms.


Ginseng. Cea./Flickr, CC BY

Gingeng, a root native to Chinese medicine has been used for centuries for a number of ailments. However, few studies have examined the effects of ginseng on menopausal symptoms.

Ginseng does not have estrogenic effects, suggesting it does not exert any hormone replacement-like effects. But it has been reported to alleviate some menopausal symptoms.

Other complementary therapies

Homeopathy is a system of alternative medicine, where substances that cause symptoms of disease in healthy subjects would cure such symptoms in sick subjects. Active ingredients are used and repeatedly diluted in alcohol or distilled water until no molecules of the original substance remains.

Studies show homoeopathy is no more effective as a menopause treatment than a placebo, and since the ingredients are extensively diluted, it is unlikely to have any side effects.

The evidence for accupuncture is mixed. rocketlass/Flickr, CC BY-NC-SA

Complementary methods such as acupuncture, moxibustion (a traditional Chinese medicine treatment that involves burning a herb called Mugwort) and reflexology are popular methods used to treat symptoms of various disease, including menopausal symptoms.

Again, there are contradictory studies, which some indicate that such complementary methods alleviate menopausal symptoms to some extent, while other studies demonstrate no benefit.

So, what’s the verdict?

Although some complementary and alternative therapies may have been used for many years with reports of great success, there is little scientific data to prove their efficacy.

And when studies have been undertaken, they’re of varying quality. Differences in findings across studies of the same product may be due to less-than-optimal trial design, variation in products and composition of products used, inadequate dosing, the length of treatment and small population size.

There’s no doubt that more clinical trials are required to ascertain the effectiveness of such methods in treating menopausal symptoms. In the meantime, exercise caution when taking complementary therapies and talk to your doctor about how they’ll interact with other medications you’re taking.

Just because they’re natural, doesn’t mean they’re risk-free.

Seven nutrients important for mental health – and where to find them

Health Check: seven nutrients important for mental health – and where to find them

October 12, 2015 2.51pm AEDT

While nutrient supplementation can have a role in treating certain psychiatric disorders, all kinds of nutrients should, in the first instance, be consumed as part of a balanced wholefood diet. PROPatrick Feller/Flickr, CC BY-SA

Disclosure statement

Jerome Sarris has received funding from Integria Health, Blackmores, Bioceuticals, Pepsico, HealthEd, Soho-Flordis, Pfizer, Elsevier, the Society for Medicinal Plant and Natural Product Research, CR Roper Fellowship, and The National Health and Medical Research Council. He is affiliated with The International Society for Nutritional Psychiatry Research.


The University of Melbourne provides funding as a founding partner of The Conversation AU.


Dietary nutrients are critical for brain structure and function, so they have a potentially profound impact on mental health. An increasingly robust body of research points to the detrimental effect of unhealthy diets and nutrient deficiencies, and to the protective value of healthy diets – along with select nutritional supplements as required – for maintaining and promoting mental health.

Research literature suggests dietary improvement and nutritional interventions may help reduce the risk, or even arrest the progression, of certain psychiatric disorders. Clinical studies support the use of certain nutrients, which influence a range of neurochemical activities beneficial for treating mental disorders, as medicinal supplements.

Evidence from clinical research supports the use of several nutritional medicines for certain psychiatric disorders: omega-3 fatty acids; N-acetyl cysteine (NAC); S-adenosyl methionine (SAMe); zinc; magnesium; vitamin D; and B vitamins (including folic acid). Other natural compounds such as amino acids, plant-based antioxidants and microbiotics (derived from fermented food or laboratory synthesis) are also known to influence brain health.

But while some evidence supports these natural compounds as having brain chemical-modulating effects, or having a role in treating certain mental disorders, we cannot currently name particular foods as being effective for the treatment of mental illness. The best nutritional advice at this point is to cultivate an unprocessed wholefood diet, with judicious prescriptive use of nutrients (if required) based on advice from a qualified health professional.

Oily fish such as sardines are the best source of omega-3 fats. Jeanne Menj/Flickr, CC BY-ND

In the meanwhile, here are seven key nutrients that may positively influence brain health, and the foods they appear in.

1. Omega-3

Polyunsaturated fats (in particular omega-3 fatty acids) have a vital role in maintaining proper neuronal structure and function, as well as in modulating critical aspects of the inflammatory pathway in the body. Taking omega-3 supplements appears beneficial for addressing symptoms of depression, bipolar depression and post-traumatic stress disorder. And it may potentially help prevent psychosis.

Omega-3 fats can be found in nuts, seeds and oysters, although the highest amounts exist in oily fish such as sardines, salmon (especially King salmon), anchovies and mackerel. Due to higher levels of mercury, larger fish, such as mackerel, should be consumed in moderation.

2. B vitamins and folate

We need B vitamins for a range of cellular and metabolic processes, and they have a critical role in the production of a range of brain chemicals. Folate (B9) deficiency has been reported in depressed populations and among people who respond poorly to antidepressants.

Several studies have assessed the antidepressant effect of folic acid (the synthetic form of folate) with antidepressant medication. Some show positive results in enhancing either antidepressant response rates or the onset of response to these medications.

Nuts are a good source of folate, amino acids and minerals. Ahmed Al Masaood/Flickr, CC BY-NC-ND

Folate is found in abundance in leafy green vegetables, legumes, whole grains, brewer’s yeast and nuts. Unprocessed meats, eggs, cheese, dairy, whole grains and nuts are, in general, richest in B vitamins. If you’re going to take supplements, it’s advisable to take B vitamins together as they have a synergistic effect.

3. Amino acids

Amino acids are the building blocks for creating proteins, from which brain circuitry and brain chemicals are formed. Some amino acids are precursors of mood-modulating chemicals; tryptophan, for instance, is needed to create serotonin. Another example is cysteine, a sulphur-based amino acid that can convert into glutathione – the body’s most powerful antioxidant.

When given as a supplement, an amino acid form known as N-acetyl cysteine (NAC) converts into glutathione in the body. We have evidence that it’s helpful in bipolar depression, schizophrenia, trichotillomania and other compulsive and addictive behaviours. Another amino acid-based nutrient known as S-adenosyl methionine (SAMe) has antidepressant qualities.

Amino acids are found in any source of protein, most notably meats, seafood, eggs, nuts and legumes.

Amino acids are found in sources of protein such as meat. Suzanne Gerber/Flickr, CC BY-NC

4. Minerals

Minerals, especially zinc, magnesium and iron, have important roles in neurological function.

Zinc is an abundant trace element, being involved in many brain chemistry reactions. It’s also a key element supporting proper immune function. Deficiency has been linked to increased depressive symptoms and there’s emerging evidence for zinc supplementation in improving depressed mood, primarily alongside antidepressants.

Magnesium is also involved in many brain chemistry reactions and deficiency has been linked to depressive and anxiety symptoms. Iron is involved in many neurological activities and deficiency is associated with anxiety and depressive symptoms as well as developmental problems. This is, in part, due to its role in transporting oxygen to the brain.

Zinc is abundant in lean meats, oysters, whole grains, pumpkin seeds and nuts, while magnesium is richest in nuts, legumes, whole grains, leafy greens and soy. Iron occurs in higher amounts in unprocessed meats and organ meats, such as liver, and in modest amounts in grains, nuts and leafy greens, such as spinach.

5. Vitamin D

Vitamin D is a fat-soluble compound that’s important as much for brain development as it is for bone development. Data suggests low maternal levels of vitamin D are implicated in schizophrenia risk, and deficiency is linked to increased depressive symptoms. But there’s little evidence to support the use of vitamin D supplements for preventing depression.

Vitamin D can be synthesised via sunlight. Dawn Ellner/Flickr, CC BY

Vitamin D can be synthesised via sunlight: 15 minutes a day on the skin between 10am and 3pm during summer, although be sure to seek professional health advice regarding skin cancer concerns. Aside from sunlight, vitamin D can also be found in oily fish, UVB-exposed mushrooms and fortified milk.

6. Plant-based antioxidants

An increase in oxidative stress and damage to brain cells has been implicated in a range of mental disorders, including depression and dementia. Antioxidant compounds (such as “polyphenols”, which are found in fruits and certain herbs) may “mop up” free radicals that damage cells to provide a natural way to combat excessive oxidation.

Consuming natural antioxidant compounds through your diet is better than taking supplements of high doses of synthetic vitamin A, C or E, as the oxidative system is finely tuned and excess may actually be harmful.

Fruits and vegetables contain these antioxidant compounds in relative abundance, especially blackberries, blueberries, raspberries and goji berries; grapes; mangoes and mangosteen; onions; garlic; kale; as well as green and black tea; various herbal teas; and coffee.

7. Microbiotics

Research shows a connection between the bacteria in our guts and brain health, which may affect mental health. When the composition of the gut microbiota is less than optimal, it can result in inflammatory responses that may negatively affect the nervous system and brain function.

Diets high in sugary, fatty and processed foods are associated with depression and poor brain health. Paul Townsend/Flickr, CC BY-ND

A balanced microfloral environment is supported by a diet rich in the foods that nourish beneficial bacteria and reduce harmful microbial species, such as Helicobacter pylori. Beneficial microflora can be supported by eating fermented foods such as tempeh, sauerkraut, kefir and yoghurt, and also by pectin-rich foods such as fruit skin.

What now?

Diets high in sugary, fatty and processed foods are associated with depression and poor brain health. While nutrient supplementation can have a role in maintaining proper brain function and treating certain psychiatric disorders, nutrients should, in the first instance, be consumed as part of a balanced wholefood diet.

There is now enough research evidence to show the importance of nutrients for mental as well as physical well-being. A discussion about diet and nutrition should be the starting point in conversations about mental health, just as it is for physical health.

If you’re interested in participating in a clinical trial prescribing nutrients for treating depression (SE Queensland and Victoria only), visit nutrientsdepressionstudy.

Chemical messengers: how hormones affect our mood

Chemical messengers: how hormones affect our mood

October 2, 2015 6.13am AEST

Some women are very sensitive to small shifts in hormones, others aren’t. Petras Gagilas/flickr, CC BY

The process of shedding the uterine lining with vaginal bleeding every month has an obvious reproductive focus, but it has also long been linked with changes to mood and behaviour. Unfortunately, this has often been an attempt to consign women to a “biologically” determined place of inferior mental functioning.

In recent times, we have learnt more about the connections between the “reproductive” or gonadal hormones and the brain, and how they affect not only women but men as well.

Gonadal hormones (oestrogen, progesterone and testosterone) are produced by the gonads (the ovaries and testes) in response to other precursor hormones found in the pituitary gland and other brain areas. These gonadal hormones impact brain chemistry and circuitry, and hence influence emotions, mood and behaviour.

Women’s hormones

Oestrogen appears to be a “protective” agent in the brain. This may in part explain why some women feel worse, in terms of their mental state, in the low-oestrogen phase of their monthly cycle.

A ‘classic’ 28 day cycle – though many women have shorter or longer cycles. Tefi/Shutterstock

Oestrogen appears to have direct impacts on dopamine and serotonin, the key brain chemicals associated with the development of depression and psychosis. In fact, animal and clinical studies show that administering oestradiol (the most potent form of oestrogen) can improve symptoms of psychosis and depression.

The concept of PMS (premenstrual syndrome) has its believers and non-believers. But essentially, there is a group of women who experience significant mental and physical symptoms in the low-oestrogen phase of their cycle every month.

Then there are women with crushing depression once per month that is known as premenstrual dysphoric disorder (PMDD). PMDD is a serious, real depression that can rob a woman of her functioning every month. The tricky part is that it’s not always exactly the week before bleeding, nor does it last exactly a week since many women do not have the “classic” 28-day cycle with ovulation at day 14, and bleeding for five days. If life were that simple!

The impact of gonadal hormones on mood is apparent at many other life stages. Around puberty, a time of major hormonal change, many girls experience various mood swings and other changes in mental health. Some women who take certain types of the combined oral contraceptive experience depressive symptoms with irritability, loss of enjoyment and even suicidal thoughts.

Postnatal depression and psychosis are key mental illnesses related to childbirth and have a major hormonal component to the onset and course of illness. This is thought to be triggered by the sudden, rapid drop in the high levels of pregnancy hormones shortly after birth.

During the transition to menopause, women experience major hormonal shifts. At this time, they are 14 times more likely than usual to experience depression. This is known as perimenopausal depression. It affects women differently than other types of depression, causing anger, irritability, poor concentration, memory difficulties, low self-esteem, poor sleep and weight gain.

Hormones can influence our moods at different stages of life Martin Novak/

Perimenopausal depression isn’t well recognised and is often poorly treated with standard antidepressant therapies. Women with this type of depression generally respond better to hormone treatments, but the link between depression and hormones is not often made.

It’s also important to note that trauma and violence can lead to chronically elevated levelsof the stress hormone cortisol, causing significant mental ill health at any time in a woman’s life. High cortisol levels have huge impacts on many brain regions, resulting in rage, suicidal thoughts, obesity and infertility.

There is a great deal of variation in the effects of hormone shifts on mood and behaviour. Some women are very sensitive to small shifts in gonadal hormones; others are not.

Men’s hormones

Recent research investigating cognition in men suggests that, just like in women, gonadal hormones influence mood and behaviour. In particular, low levels of testosterone can lead to an age-related condition called andropause.

Andropause is sometimes described as the “male menopause”. This is not strictly accurate since unlike female fertility, male fertility does not end abruptly with a fixed hormone decline. Andropause is caused by a significant decline in testosterone levels to below the normal range for young men. This can result in erectile problems, diminished libido, decreased muscle strength and decreased bone mass.

To complicate matters, testosterone is converted to oestradiol (the most potent form of oestrogen) in men. Altered testosterone/oestradiol ratios can cause problems with memory function, depression, irritability, sleep, fatigue and occasionally even hot flushes.

There is controversy about how much of these changes are a normal part of ageing. Many other factors such as obesity, diabetes and excessive alcohol consumption can also cause low testosterone levels. So andropause should not be viewed as a disease, but as a clinical syndrome with a great deal of variability.

Testosterone levels reduce with age. carballo/Shutterstock

In some men, testosterone-replacement has been used successfully to treat andropause. But this needs to be done under strict medical supervision because of the many potential side effects including prostate problems, elevated cholesterol and increased rage.

A great deal more research is required in both men and women on the role of gonadal hormones and mental health. But the era of splitting the mind from the body should be long gone.

More than one-third of cancers can be avoided if Australians modify their lifestyle

Interesting information for all of us. The HRT they mention here is the standard, synthetic HRT most women get. There is a diference to the Bioidentical HRT that I use – this has been well documented in previous posts. See :

Bioidentical Hormones for Safety and Efficacy

More than one-third of cancers can be avoided if Australians modify their lifestyle

October 7, 2015 6.28am AEDT

Moderate intakes of red meat and alcohol can prevent a cancer diagnosis. from

Nearly 40,000 cancers diagnosed in Australia can be prevented if people avoid known risk factors for the disease, according to research published today.

In 2010, 116,850 Australians were diagnosed with invasive cancer. The new study identifies 13 areas where people can alter their lifestyle to prevent a third of these.

Led by clinicians at the QIMR Berghofer Medical Research Institute, researchers applied international measurements to calculate Australian data.

Published today in the Australian and New Zealand Journal of Public Health, the study showed smoking, ultraviolet radiation, body weight, diet, and alcohol, contributed to 90% of all preventable cancers.

Modifiable risks accounting for the remaining 10% of cancers were:

  • Red and processed meat
  • Inadequate fibre intake
  • Inadequate intake of vegetables
  • Inadequate intake of fruit
  • Inadequate physical activity
  • Infections such as hepatitis B and C, human papilloma virus, Helicobacter pylori bacterium, HIV and Epstein-Barr Virus.
  • Hormone replacement therapy (HRT)
  • Oral contraceptives
  • Inadequate breast feeding.

Director of the Sansom Institute for Health Research, Ian Olver, said the often convoluted reports about causes of cancer distracted people.

“People think, ‘oh everything causes cancer, I don’t need to be worried about it’. But this study actually refocuses it on the things that can prevent about a third of them – and it’s simple lifestyle changes,” he said.

Risk factors considered for the report had to meet three conditions: be classified by the World Health Organization or the World Cancer Research Fund as a cause of at least one cancer type; be modifiable; and there had to be reliable data on numbers of Australians exposed to the particular risk.

Associate Professor in Nutrition at Deakin University, Tim Crowe, said while the research was significant in its credibility, there was no magic formula it exposed to avoiding cancer.

“It’s about eating plenty of plant-based foods and fibre, being active, not drinking too much and trying to maintain as healthy a body weight as possible,” he said.

“You could apply those recommendations to reducing the risk of diabetes and heart disease. It’s a common theme across many chronic diseases.”

The study suggests nearly 2,000 cancer cases diagnosed in Australia in 2010 were attributable to inadequate intakes of fruit and vegetables.

Low levels of dietary fibre were responsible for at least 1,000 – and possibly up to 2,600 – bowel cancers.

Professor Sanchia Aranda, chief executive officer of Cancer Council Australia, which commissioned the study, said bowel cancer was a major issue in the country.

“We have a particularly low participation in our national bowel screening program in Australia. Our target is 70% of the target population and we’re sitting at about 33% at the moment,” she said.

The report showed red and processed meat were significant risk factors for bowel cancer, accounting for about 17% of all such new diagnoses in 2010.

It states if Australian adults consumed less than 65 grams of red and processed meat per day, around 800 fewer cases of bowel cancer would have been diagnosed in 2010.

Professor Aranda said Australia’s culture of barbecues with a high red meat component contributed to it sharing the highest level of bowel cancer in the world with New Zealand.

She also said there was a worrying rise in rates of liver cancer in Australia.

The study showed the hepatitis virus contributed to around 30% of liver cancer diagnoses. But alcohol and tobacco were responsible for 13% and 21% respectively.

“It’s always been thought the rising rates of liver cancer was largely due to infections.

“But in France, recent reports suggest that about 50% of their liver cancer is due to drinking too much alcohol,” Professor Aranda said.

Hormone replacement therapy (HRT) for menopausal women was found to be both a risk and protective factor, depending on the type of cancer.

The study suggested more than 500 Australian women – and perhaps as many as 675 – developed cancer in 2010 as a consequence of using HRT. But nearly 90 cancers were prevented when women used the therapy.

Professor Olver said the information was complicated and women using HRT who were worried about their cancer risk should consult with their doctor.

Women most at risk of cancer are those using the therapy for longer than five years.

“There are a lot of factors that have to be balanced. If you’re having dreadful symptoms from being post-menopausal, then you need to do something about them because it ruins your quality of life,” Professor Olver said.

“This is something individual patients have got to talk to their doctors about; their individual situations and risk factors and reasons for needing to be on or not be on HRT.”

Overall, the study showed tobacco smoke to be the only risk factor with no safe level of intake, while there was no limit to recommended levels of fruit and vegetable consumption.

“The interesting thing about this is that it’s not saying to cut out anything,” said Tim Crowe.

“It’s really about having more of. More of plant-based foods, and not going overboard on eating red meat.”

Zika, dengue, yellow fever: what are flaviviruses?

Zika, dengue, yellow fever: what are flaviviruses?
February 5, 2016 6.07am AEDT .

The Aedes Aegypti mosquito is responsible for transmitting some flaviviruses, including Zika. Ian Jacobs/Flickr, CC BY-SA

Jason Mackenzie
Associate Professor, Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity

Disclosure statement

Jason Mackenzie receives funding from the National Health and Medical Research Council of Australia
You might have heard the term flavivirus recently due to the outbreak of Zika virus in Central and South America. Zika, along with West Nile virus, dengue, yellow fever and Japanese encephalitis, belongs to this family of virus – of which many are threats to public health.

Flaviviruses are defined by the shape and size of the virus particle (which is extremely small and not visible by the naked eye but requires a high powered electron microscope). They are able to replicate and spread within both insects and mammals, and they infect humans and domesticated animals.

How are flaviviruses spread?

Flaviviruses are arboviruses, which means they are spread via infected arthropod vectors such as ticks and mosquitoes.

Some flaviviruses (such as West Nile) exist in a bird-mosquito cycle and infections in humans are typically incidental and a “dead-end” for the virus. This means it cannot be transmitted to a new mosquito.

However, yellow fever, dengue and Zika exist predominantly in a human-mosquito cycle. These viruses grow very well in the human body and therefore allow the re-infection of mosquitoes.

The geographical location of flaviviruses is determined primarily by the distribution of the mosquito or tick vector. For the most part, they are confined to tropical and sub-tropical regions, particularly Southeast Asia and South America. However, Australia has two native flaviviruses – Murray Valley encephalitis and its own strain of West Nile called “kunjin”. Australia also has epidemic episodes of dengue occurring in far North Queensland.

The Aedes aegypti mosquitoes responsible for spreading Zika and yellow fever have been shown to be able to adapt in high-density urban areas, which means it is important to find methods to contain flaviviruses. The urbanisation of the ever-growing human population and the impact of climate change are increasing the population at risk of contracting flavivirus infections.

How do they attack the body?

A flavivirus is transmitted via the bite of an infected tick or mosquito. It enters the bloodstream and invades and infects cells called monocytes in the immune system. The virus is then transported to lymph nodes and targets organs within the body, where different flaviviruses cause different symptoms.

Symptoms generally take seven days to appear and can last for an additional seven days. Some flaviviruses, such as West Nile, can enter the brain and induce encephalitis, whereas yellow fever infects the liver, dengue can cause shock and haemorrhage within the body, and Zika induces joint and muscle pain upon infection.

It is not currently understood why these symptoms occur, but we’re conducting research to try to uncover how the viruses affect the body.

Are there treatments?

Currently vaccines are available for some flaviviruses – including yellow fever, Japanese encephalitis and tick-borne encephalitis virus. A vaccine for dengue was recently licensed for use in Brazil, the Philippines and Mexico.

The development of a dengue vaccine has been challenging due to the different variations of the virus. Being exposed to one type potentially worsens subsequent infections with another type of the same virus. To avoid this complication, the current vaccine trials have included all four dengue variations in their formulations.

A recent advancement in controlling flaviviruses is with the use of a bacterium called Wolbachia. Mosquitoes that harbour this bacteria are completely resistant to subsequent flavivirus infection, and the bacteria can infect and remain persistent within mosquito populations.

If flaviviruses can’t establish infection within the vector host, this limits its maintenance in the environment. The Doherty Institute, along with Monash and Oxford University, is researching implementation of this form of biological control.

Cognition and mood in perimenopaus

More studies on the effect of Estrogen on women around the menopause. The benefits of this hormone to women just keep on showing up in studies.
J Steroid Biochem Mol Biol. Author manuscript; available in PMC 2015 Jul 1.
Published in final edited form as:
PMCID: PMC3830624

Cognition and mood in perimenopause: A systematic review and meta-analysis



It is suggested that declines in estrogen around menopause are associated with declines in cognitive functioning as well as increased risk of depressive symptoms and depressive disorders. Existing studies of objective cognitive function and mood have differed in the criteria used to stage the menopausal transition and in the outcome measures used. The purpose of this review was to synthesize the existing studies of the relationship between menopausal stage and neuropsychological performance and depression.


A search of the literature of observational studies was performed using PubMed. Four cross-sectional studies on menopausal transition stage and cognitive function and four longitudinal studies on menopausal transition stage and risk of depression, as measured by symptom inventories and structured clinical interviews, were selected. For the cognitive outcomes, fixed effects models were used to estimate overall standardized effect sizes. For the depression outcomes, the results of group comparisons were summarized using the log odds ratio and its estimated standard error.


Postmenopausal women performed significantly worse than pre- and perimenopausal women on delayed verbal memory tasks, and significantly worse than perimenopausal women on phonemic verbal fluency tasks. Peri- and postmenopausal women were at significantly increased risk of depression, as measured by standard symptom inventories and structured clinical interviews, than premenopausal women.


The menopausal transition is a time of increased vulnerability to cognitive declines and increased risk of depressive symptoms and depressive disorders. However, these results cannot necessarily be generalized beyond the studies included in this review.

Keywords: Perimenopause, menopausal transition, cognition, memory, depression

1. Introduction

Perimenopause is commonly defined as the period of time in which the first endocrine, biological and clinical features of approaching menopause begin, up through one year after the final menstrual period (FMP). Menstrual cycle changes may be seen as early as four to eight years prior to menopause [1], though the average duration of perimenopause is four years [2]. The latest consensus criteria for staging reproductive aging (STRAW+10) [3] are based on self-reported bleeding patterns. Perimenopause is defined as encompassing three stages: early menopausal transition (−2): persistent cycle irregularity, defined as ≥7 day difference in length of consecutive cycles at least twice over the prior 10 cycles; late menopausal transition(−1): an interval of amenorrhea of ≥ 60 days in the prior 12 months, and early postmenopause (+1a): the first year following the final menstrual period (FMP). STRAW+10 further delineates early postmenopause as encompassing the first 6 years following the FMP and late postmenopause as encompassing the remaining lifespan; however only the first year following the FMP is part of perimenopause.

Most large-scale epidemiological studies of midlife women that have informed our understanding of perimenopause, including the Study of Women’s Health Across the Nation (SWAN) and the Seattle Midlife Women’s Health Study, were initiated prior to the initial publication of the original STRAW guidelines [4], and each study uses somewhat different staging criteria. For instance, the SWAN defines the late perimenopausal stage as no menses for 3-11 months [5], and the Seattle Midlife Women’s Health Study defines an early, middle and late transition [6]. Most studies have utilized 12 months of amenorrhea as defining postmenopause. This transitional period is commonly associated with cognitive and affective changes, though the actual severity and mechanisms of such reported changes are not well understood.

Reproductive aging in women is associated with a decrease in ovarian estrogens (estradiol and estrone) and progesterone and an increase in serum follicle stimulating hormone (FSH) [7,8]. These changes are most pronounced in the two years prior to, and the two years after, the FMP [9]. Within individual women, however, perimenopause is characterized by widely fluctuating levels of estrogen, as opposed to a steady decrease [10,11]. The relationship between these hormonal changes, cognition, and affect has yet to be fully elucidated.

It is suggested that declines in estrogen around menopause are associated with declines in cognitive functioning as well as increased risk of depressive symptoms and depressive disorders [see 1215 for reviews]. Estrogen promotes neuronal growth and survival [16] and acts on the cholinergic system, which is closely linked to cognitive functioning, particularly memory [17,18]. Several studies suggest that cognitive function supported by the prefrontal cortex may be particularly sensitive to estrogen [19,20,21,22,23]. Estrogen also has a role in neurotransmitter systems involved in depression. For instance, estrogen acts as a serotonergic agonist/modulator by increasing receptor binding sites, synthesis and uptake in animal models [24] and post-menopausal women [25]. Estrogen therapy (ET) improves mood in women with perimenopausal–related depression [26, 27] as well as in surgical and naturally post-menopausal women who report depressive symptoms [28, 29]. ET also has beneficial effects when combined with selective serotonin reuptake inhibitor (SSRI) treatment [30].

The majority of women report forgetfulness and concentration difficulties during the menopausal transition [31]; however, few studies have examined objective cognitive functioning in women as they transition through menopause. The Melbourne Women’s Midlife Health Project was the first to investigate the relationship between reproductive aging stage and measured memory performance [32]. This cross-sectional study found no differences between women in the early perimenopause, late perimenopause and postmenopausal stages on objective memory tests; however, there was no premenopausal group used for comparison. Our understanding of the relationship between menopausal stage and cognition was heightened with the publication of longitudinal data from the SWAN [33]. Those data showed that perimenopausal women did not show the expected improvements in verbal memory and processing speed with repeated test administration that pre- and postmenopausal women did. Despite the strengths of design and follow-up, the study was limited by a small cognitive battery and the use of a verbal memory test with a low ceiling. In all, six cross-sectional and three longitudinal studies have examined whether cognitive function varies by menopausal transition stages. Of these nine studies, two cross-sectional studies and one longitudinal study report no differences across stages, whereas four cross-sectional and two longitudinal studies report small, but significant differences. Differences in staging criteria and cognitive batteries may account for some of these discrepancies.

Perimenopause is also associated with affective changes, ranging from an increase in depressive symptoms to diagnosed Major Depressive Episode. The Massachusetts Women’s Health Study was one of the first studies to utilize a randomly sampled, community-based cohort of midlife women, standardized definitions of menopausal status, and a valid and reliable symptom inventory. In their cross-sectional analysis of midlife women, they found no relationship between reproductive aging stage and depressive symptoms [34]; however, a longitudinal follow-up revealed that those women who experienced a long perimenopause (over 27 months) were twice as likely to develop elevated depressive symptoms [35]. Since then, numerous longitudinal studies have demonstrated an increased risk of depressed mood in the menopausal transition compared to the premenopausal stage.

The purpose of this review was to synthesize the existing studies of the relationship between menopausal stage and neuropsychological performance and depression. We required that studies include a premenopausal comparison group as a referent group that represented cognitive or affective function prior to the menopausal transition, since studies lacking that control group might underestimate the association between reproductive aging and cognition or mood. While a prospective, longitudinal design is optimal, there were only three longitudinal studies on cognition [33, 36, 37], and only two met our criteria [33, 36]. Both of these were from the SWAN; one from the Chicago site [36] and the other from the entire cohort [33]. Given the lack of longitudinal data on other cognitive domains besides working memory, processing speed and verbal memory, we undertook a meta-analysis of cross-sectional studies. Such an analysis also addresses the generalizability of the SWAN findings to other cohorts. Given the abundance of reports on menopausal status and mood, and the advantages of longitudinal studies compared to cross-sectional studies, we focused on large-scale longitudinal cohort studies of the association between menopausal status and mood.

4. Discussion

In this meta-analysis, we analyzed the results of several observational studies on the relationships between menopausal transition stage and cognition and mood in midlife women. The data suggest that the peri- and postmenopausal stages are associated with decreases in delayed verbal memory compared to premenopause. Additionally, the postmenopausal stage is associated with decreases in phonemic verbal fluency compared to perimenopause. The data also suggest that women are at a significantly increased risk of developing depression, as measured either by symptom inventory or structured clinical interviews, in the peri- and postmenopausal stages than in premenopause.

Dry eye in postmenopausal women: a hormonal disorder.

Menopause. 2015 Oct 27. [Epub ahead of print]

Dry eye in postmenopausal women: a hormonal disorder.

Sriprasert I1, Warren DW, Mircheff AK, Stanczyk FZ.

Author information



This review examines the etiology and pathophysiology of dry eye disease in postmenopausal women, and describes the steroid reproductive hormone influences that may contribute to its development.


We have reviewed the relevant studies on dry eye disease related to hormonal status and hormone therapy (HT) in both animal models and humans.


Although both low and high estrogen levels have been associated with symptoms of dry eye disease, low androgen levels are a more consistent factor in its etiology. Postmenopausal HT with estrogen or estrogen plus progestogen has shown a limited benefit for dry eye symptoms and may even result in progression of meibomian gland dysfunction, decreased tear film break up time, and tear flow reduction. However, systemic or local androgen treatment has shown promising results in improving dry eye symptoms.


Because of the high incidence of dry eye among postmenopausal women that may be related to the hormonal treatment, we propose that a multidisciplinary approach should be considered between gynecologists and ophthalmologists in management of this disorder.

How does the immune system learn?

Explainer: how does the immune system learn?

September 22, 2015 1.18pm AEST

The only thing standing between invaders such as bacteria, viruses, parasites and fungi and our devastation is our immune system. kurtxio/Flickr, CC BY-SA

Disclosure statement

Steven Maltby receives funding from The Canadian Institutes of Health Research (CIHR), The University of Newcastle and the Hunter Medical Research Institute (HMRI). He works for the University of Newcastle and the HMRI.

Parts of the whole

The immune system is made up of two equally important parts: innate immunity and adaptive immunity.

Innate immunity rapidly responds to invaders; innate immunity cells deal with more than 90% of infections, removing them within hours or days. These cells recognise invaders by looking for broad shared patterns, such as common molecules on the surface of most bacteria. They might look for lipopolysaccharides (LPS), for instance, a molecule found in many bacterial cell walls.

When the innate response fails to fend off an invasion, the invaders are handled by adaptive immunity. Instead of broad patterns, each adaptive cell sees a very specific pattern. This could be one particular protein on the surface of a virus or bacteria.

But because the adaptive immune system doesn’t know what invaders it may meet, it makes millions of different cells, each of which is created to recognise a random different pattern. One adaptive cell may recognise only the flu virus, for instance, while another may recognise only a single type of bacteria.

When adaptive immune cells recognise an invader, they replicate so they form an army to kill it. This very specialised process can take a week the first time we’re infected by a new invader. If we’re exposed to a flu virus, for instance, only the small number of adaptive cells that can randomly recognise flu viruses are activated to remove infection, which is why it takes time to fight it off.

After an invader is removed, the adaptive cells that recognised it are kept, as specialised “memory cells”. If we see the same invader again, those cells can respond before we get ill. This is how the adaptive immune system learns.

Always learning

The traditional understanding of the immune system was that innate immune cells couldn’t learn; that they dealt with each invader the same way every time. But new evidence suggests innate responses are changed by previous infections or vaccination, through “innate learning” or “trained immunity”.

Only the small numbers of adaptive cells that recognise flu viruses are activated to remove infection, which is why it takes time to fight off the flu. Juli/Flickr, CC BY-NC-ND

Because innate learning changes innate immune cells, it has broad effects on how the immune system deals with infections. That means infection by one invader can cause changes in how the immune system deals with a completely different invader. In contrast, adaptive learning leads to very specific protection against repeat infection by the same invader.

Innate learning can have unexpected effects on how our immune system deals with secondary infections (infections that occur during or after a different infection). Here’s an example: the “bacille Calmette-Guerin” (BCG) vaccine is designed to protect against tuberculosis, and does a good job at protecting from tuberculosis as expected. But it also protects against infection by a completely unrelated invader, Candida albicans.

Candida albicans infection causes “candidiasis“, more commonly known as thrush or yeast infection. Studies of BCG-vaccinated patients had previously suggested that vaccination protects against infections other than tuberculosis. But how this happened wasn’t understood.

Then researchers showed protection from yeast infection happened through an improved innate response. The innate immune cells “learn” from the vaccine and protect from yeast infection for up to three months afterwards. And this is just one of a growing number of studies showing that innate immune cells can learn.

These studies extend to primitive invertebrates, including flies and mosquitoes. Invertebrates completely lack adaptive immune cells, so any immune memory responses they have are from innate learning.

In mice, herpesvirus infections can protect from completely different bacterial infections. Rather than responding the same way to every invader, innate learning changes our immune responses based on previous experiences.

Recent evidence also suggests immune learning is strongly affected by environmental factors, including diet, lifestyle, our surroundings and previous infections.

Immune responses to the yearly flu vaccine, for example, are impacted more by environmental factors than genetic differences. This suggests we can improve our immune responses by altering life experiences.

Rather that being stuck with the immune system we genetically inherit, research is showing that immune responses are shaped by life experiences. It provides hope that we can improve immunity and reduce disease through changes in lifestyle and our environment.